NamedWork: Enhancing Evolution: The Ethical Case for Making Better
People (Nonfiction work)

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Geographic Scope: United States Geographic Code: 1USA United States

Accession Number:

220561136

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In December 2008, a study group convened by Rockefeller University
published a commentary in Nature recommending societal adoption of
cognitive-enhancing medications by healthy persons. The group included a
prominent bioethicist, John Harris, who for two decades has recommended
various enhancements--pharmacological, hormonal, chemical, genetic--as
beneficial to human beings. Harris's most systematic defense of
enhancements, including germ line and embryo enhancements, is presented
in his very provocative book, Enhancing Evolution: The Ethical Case for
Making Better People. The biotech revolution has brought us to a point
where the human species, Harris contends, "will replace natural
selection with deliberate selection, Darwinian evolution with
'enhancement evolution'" (p. 4).

Harris initiates his argument with a thought experiment: Given the
lengths many parents will go to seek the best educational opportunities
and social advantages for their children, why not instead achieve the
desired qualities--such as enhanced intelligence, better health and
fitness, and improved physical and mental capacities--through such means
as genetic engineering, regenerative medicine, reproductive technology,
or nanotechnology, particularly by selecting for traits in the human
embryo? In either context, Harris suggests, our goals are the same. We
have simply changed from social engineering to genetic or
pharmacological means. Once we have willed the ends, we have necessarily
willed the means to realize those ends.

This opening rhetorical reflection provides a compressed version of
Harris's general argument on enhancements through medical
interventions: Having embarked on the path of "making better
people" through education, athletic camps, music lessons, and the
like, it's not possible to claim these ends are offlimits to the
medical enterprise; indeed, we are more likely to succeed through
medical and biotechnological methods. Enhancements have already been
incorporated within medicine. For instance, if one follows the
trajectory from glasses to contact lenses to LASIK surgery, it seems
arbitrary to draw a line against enhancements for night vision.
Vaccinations against diseases like smallpox suggest we are morally
committed to accept vaccinations that provide immunity against disease.
And life-prolonging measures, such as organ transplants, usher us into a
moral realm that endorses regenerative technologies to reverse aging or
even to achieve a biological immortality, which Harris refers to as
"the Holy Grail of enhancement" (p. 59).

Harris sees no conceptual difference between therapy and
enhancement, nor any defensible criteria of normal human functioning or
flourishing that traditionally have grounded objections to enhancements.
He denigrates religious considerations as superstition and expressions
of prejudice. The philosophical basis he offers for enhancements shows
how much ground has been traversed in supplanting Darwinian with
enhanced evolution: "Medicine can be described as 'the
comprehensive attempt to frustrate the course of nature'" (p.
35). Remarkably, Harris offers no philosophical account or defense of
this view of the vocation of medicine, or of medicine's relation to
nature, even though this claim opens the way to a comprehensive
medicalization of life, from preconceptual screening to end-of-life
treatments.

According to Harris, the choice to use enhancement technologies is
also protected by "the democratic presumption." This
presumption amounts to a twenty-first century restating of Mill's
"harm principle"--that the only ground for intervening with or
restricting personal liberty is the prospect of harm to others. For
Harris, such harms must be "real and present," not
"speculative and future." There are at least two issues here
that Harris needs to address--one focusing on the relationship of law
and moral discourse (with the latter here in danger of being eclipsed by
the former), and the other on how we should address uncertainty about
outcomes in moral deliberation. While Harris rejects a mechanism like
the "precautionary principle" in the face of uncertain
outcomes, why we should presume enhancements are necessarily conducive
to personal benefit and social betterment is not evident.

The philosophical and moral difficulties with Harris's
proposal are revealed by his equivocal use of the language of
"better" people in the subtitle and opening chapter of his
book. "Better" seems to entail an expansion of various human
capacities, including intelligence, memory, health, and longevity, but
to have absolutely nothing to do with moral character, integrity, or
virtue. Nor is it necessarily the case that becoming a
"better" or enhanced person in Harris's understanding
will fulfill aspirations for relationships, happiness, and well-being.

It is important to ask which people have the opportunity to become
"better." Harris proposes that enhancements will somehow make
us "fairer" persons even as he acknowledges that
stratification will be present in the initial stages of an enhancement
project. He then relies on an inchoate theory of the diffusion of new
technology in claiming that "procedures which start expensive, rare
(even elitist), and risky often become widely available, if not
universal, cheap, ... and widely accessible" (p. 31). Perhaps this
mode of diffusion is reasonable in a socialized health care system, but
in a country like the United States, where 47 million people lack access
to basic health care--that is, where health care itself is not
"universal, cheap, ... and widely accessible"--a proposal to
open enhancements to an elite while many citizens go without basic care
seems an egregious misallocation of scarce resources and a violation of
the principles of justice and equal opportunity.

Finally, it is puzzling just how Harris considers his advocacy of a
moral (and, if necessary, legally enforceable) obligation to not only
support but also participate in the biomedical research required to
further enhancement as being at all compatible with the democratic
presumption. The criteria for restricting my liberty on the model of the
democratic presumption is that my acts pose a real and present harm to
others, but the obligation to participate in enhancement research
restricts my liberty on the grounds of a speculative benefit to unknown
persons in future generations.

Less broad in imaginative scope (no pretensions to biological
immortality), but more soundly argued philosophically is Ronald M.
Green's Babies by Design: The Ethics of Genetic Choice. Harris and
Green are actually reasonably close in their conclusions on most
enhancement prospects, and there are echoes of Harris's title in
Green's assertion that we are entering the "era of directed
human evolution" (p. 2). And Green makes use of a similar
casuistical method, continually citing instances of practices we
currently accept as precedents that make drawing a line against most
forms of enhancement difficult.

Still, Green's book is much more solidly grounded in ongoing
scientific research; he devotes an entire chapter to "how we will
do" enhancements scientifically, not just conceptually. He reflects
thoughtfully on the dynamics of the parenting-child relationship and the
impact on it of genetic choice, which is a marked contrast to the
individualistic narcissism often characterizing Harris's arguments.
Green takes objections to genetic design as "healthy warnings"
rather than subjects for philosophical ridicule and devotes a chapter
(albeit an unsatisfactory one) to religious considerations under the
concept of "playing God," instead of dismissing such views as
irrational superstition.

Green's assessment of what hinders societal support of
enhancement technologies, especially in the realm of reprogenetics, is
that we are prone to what he designates as "status quo bias."
We have managed to delude ourselves into thinking that, medically
speaking, we are in the best of possible worlds, so any projections of
progress from genetic interventions seem fraught with moral peril and
social catastrophe (p. 104). Yet, as Green rightly observes, had prior
generations been afflicted with the same bias, many of the advances in
biomedicine and health care that we now take for granted would not have
occurred.

While Green and Harris agree that the traditional distinction
between therapy and enhancement is no longer sustainable, Green does not
believe medical research or society must be on the fasttrack quest for
the biological "Holy Grail." He distinguishes between
"preventive enhancements" such as vaccines, where the aim is
related to maintaining health, and "pure enhancements," where
the goal is "gratifying the wishes of normal and healthy people for
improved performance or superior capabilities" (p. 61). Harris
would surely challenge Green on this point, but Green, I believe, has
made a compelling case that regarding enhancements (and moral choices in
general), we are not solely concerned with outcomes but also with
intentionality, design, and purpose; and, further, that a
"wish" does not have the moral status of a "need."

Green also probes the implications of genetic design for the family
as a moral community and social unit. He distinguishes parents'
role as "guardians" of children's best interests from
their role as "gardeners" who raise children not only for the
child's sake but also for their own purposes. The morally
responsible parent will balance these two roles, with the
"guardian" restraining the "gardener."

While Green's insight that "parental love almost always
prevails" (p. 114) may be generally valid, this doesn't quite
explain why parents are willing to spend substantial financial
resources, advance considerable emotional and relational investment, and
undergo (for the female) a physiological ordeal to obtain a particular
kind of child through genetic choice. Green's parenting models
could be infused more with what theological ethicist William F. May
refers to as "accepting" love as a constraint on the
"transformative" love that motivates the parental quest for a
specific kind of child. In general, Green's discussion of parental
responsibility is a very thoughtful refutation of assertions that
genetic modifications will "threaten" the family, but he is
less successful in illustrating how having "babies by design"
will, as he claims, "improve" on family life.

Both authors support parents' freedom to make responsible
choices about genetic modification. Green has a narrower and Harris a
broader notion of the meaning of responsibility in this context:
Green's perspective is that parents can be responsible for harm
when a child is born with a preventable impairment, while Harris would
add that parents are also responsible if a child is deprived of a
possible enhancement.

On either account, however, affirming procreative and parental
autonomy for genetic design of children inevitably invites expanded
medicalization of such choices, including increased use of technologies
of reproduction, screening, selection, and manipulation. As parents
assess their responsibilities to their unborn progeny, they are unlikely
to be immune from pressures to conform and to control.